Surgery

Question 1

What define oligouria?

Answer 1

< .5 mL/kg/hour

Question 2

How often does uterine perforation occur during hysterosocpy procedure?

What increases this risk?

Answer 2

1.5%

Cervical stenosis, uterine scar tissue

Question 3

What is the most valuable in detecting gas embolus intraoperatively?

Answer 3

End Tidal CO2

Other signs:

• Tachycardia
• Arrhythmia
• Hypotesnion
• Increased CVP
• Mill Wheel Murmur
• Cyanosis

**Capnography or capnometry are more valuable than oximetry in detection of gas embolus because the end tidal CO2 decreases because of a decrease in cardiac output and increase in dead space

Question 4

What should you do if you suspect a gas embolis intraoperatively?

Answer 4

Release of pneuoperitoneum

Place in steep trendelenberg

Position on the left side

100% fiO2

Hyperventilate to help elimination of CO2

Question 5

Which generation of cephalosporin is the first line of choice for preoperative gynecologic surgical procedures?

Answer 5

Ancef (Cefazolin) is a first generation cephalosporin

Question 6

Branches of anterior division of internal iliac artery?

Answer 6

Uterine
Umbilical
Superior vesical
Obturator
Internal pudendal
Inferior Gluteal
Middle Rectal
Vaginal

Question 7

Branches of posterior division of internal iliac artery?

Answer 7

Superior gluteal
Lateral Sacral
Iliolumbar

Question 8

In order to expand the uterine cavity with distension media during hysteroscopy, what pressure in mmHg must be reached?

Answer 8

To expand the cavity intrauterine pressures of these media must reach 45-80 mmHg

Question 9

Hysteroscopic distension medium that is electrolyte rich and can use BIPOLAR cautery?

Answer 9

LR

NS

Question 10

What is the maximum fluid deficit allowed for LR/NS?

Answer 10

2,500 mL

Question 11

During hysteroscopy, what mediums allow you to use monopolar cautery?

Answer 11

Glycine
Sorbitol
Mannitol

*Electrolyte POOR

Question 12

What is the maximum fluid deficit allowed for Glycine/Sorbitol/Mannitol?

Answer 12

1,000 mL

Question 13

Risk of using low viscosity, electrolyte poor solutions for hysteroscopy? (Glycine, Sorbitol, Mannitol)

Answer 13

Can cause hyponatremia
Decreased serum osmalality
Potential for cerebral edema and death